HomeMy WebLinkAboutCAG2019-086 - Insurance Certificate - Valley Cities - 06/30/2020-06/30/2021 CoverageClient#:709605 VALLECIT
ACORD,. CERTIFICATE OF LIABILITY INSURANCE
COVERAGES CERTIFICATE NUMBER:REVISION NUMBER:
DATE (MM/DD/YYYY)
6t17t2020
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTTTUTE A CONTRACT BETWEEN THE ISSUING TNSURER(S), AUTHORTZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: lf the certificate holder is an ADDITIONAL INSURED,
lf SUBROGATION lS WAIVED, subject to the terms and conditions
the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
USI lnsurance Services NW HC
601 Union Street, Suite 1000
Seattle, WA 98101
206 441-6300
1fi8.",F.. =,u,
206 441-6300 610-362-8530
INSURER(S} AFFORDING COVERAGE NAIC #
1N5URER A : Philadelphia lndemnity lnsurance Co.1 8058
INSURED
Valley Cities Counseling & Consultation
325 W Gowe St
Kent, WA 98032
INSURER B
INSURER C
INSURER D
INSURER E :
INSURER F :
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVEBEEN ISSUED TOTHE INSURED NAMEDABOVE FORTHE POLICYPERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITIONOF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID cLAll\ils.
INSRLTR TYPE OF INSURANCE INSP WN POLICY NUMBER tsoLtuY Et-t-(MM/DD/YYYYI POLICY EXP(MM/DD/YYYY}LIMITS
A X COMMERCIAL GENERAL LIABILITY
CLAIMS.MADE OCCUR
X Retro 01/28/1987
X WA Stop Gap
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY
PRO-
JECT LOC
OTHER:
X PHPK2143303 061301202'l EACH OCCURRENCE $1,000.000
DAMAGE TO RENTEDPRtrMlsFs /F, 6^."rran^a\$1,000.000
MED EXP (Anv one Derson)$20,000
PERSONAL & ADV INJURY $ 1.000.000
GENERAL AGGREGATE $ 3.000.000
PRODUCTS - COI\4PIOP AGG s3.000.000
WA Stop Gap $$1M/$1M/$1M
A AUTOMOBILE LIABILITY
ANYAUTO
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
SCHEDULED
AUTOS
NON-OWNED
AUTOS ONLYX
PHPK2143303 06/30/2020 06t30t2021 COMBINEIJ SINGLE LIMIT s1.000.000
BODILY INJURY (Per person)$
BODILY INJURY (Per accident)$
$
$
A X UMBRELLA LIAB
EXCESS LIAB
x OCCUR
CLAII\4S.MADE
PHUB725836
Retro 01/2811987
0613012020 06t30t2021 EACH OCCURRENCE $5.000.000
AGGREGATE $5.000.000
DED X nerer'rrror.r s10.000 $
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORY'O*'*CRYCXE"'''U= J4
oFFICERyMENIBER EXCLUDFD? L l(Mandatory in NH)
lf yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
I PER
I qrATr rrF OTH-FA
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EI,4PLOYEE $
E.L. DISEASE - POLICY LIMIT $
A Professional Liab
Claims-Made
Retro 01/28/1987
PHPK2143303 )6130t2020 06130t2021 $1,000,000 Per lncident
$3,000,000 Aggregate
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Certificate Holder is additional insured as respects their interest in the operations of the Named lnsured.
Evidence of lnsurance for Professional Liability.
TE
ACORD 25 (2016/03)
#s29062549/M
1 of 1
29062340
@ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
BXHJT
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE W|LL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Gity of Kent
220 4th Ave S
Kent, WA 98032-0000
i
,{4F"c-4*
AUTHORIZED REPRESENTATIVE
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED
PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
POLICY NUMBER: PHPK2143303
A. Section ll - Who ls An lnsured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property
damage" or "personal and advertising injury"
caused, in whole or in part, by your acts or
omissions or the acts or omissions of those acting
on your behalf:
1. ln the performance of your ongoing operations;
or
2. ln connection with your premises owned by or
rented to you.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law;and
2. lf coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that whiclr you are
required by the contract or agreement to
provide for such additional insured.
COMMERGIAL GENERAL LIABILITY
cG 20 26 04 13
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section lll - Limits Of lnsurance:
lf coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
lnsurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of lnsurance shown in the
Declarations.
Name Of Additional Insured Person(s) Or Organization(s):
City of Kent
lnformation uired to com this Schedule if not shown will be shown in the Declarations
cG 20 26 04 13 @ lnsurance Services Office, lnc.,2012 Page14 of 81